Pancreatic Cancer: Stages

What does stage of cancer mean?

The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. He or she can also see if the cancer has grown into nearby areas, and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

What are the stages of pancreatic cancer?

The TNM system

The TNM system is a standard way of describing the extent of a cancer's growth. It’s the most common system used to stage pancreatic cancer. It was developed by the International Union Against Cancer and the American Joint Committee on Cancer (AJCC). Here is what the letters stand for in the TNM system:

T refers to the size of the tumor in the pancreas and whether it has grown into nearby areas.

N refers to whether any lymph nodes in the area of the pancreas contain cancer cells.

M refers to whether the cancer has spread to other, distant organs in the body (metastasized). These can include your liver or lungs.

Stage grouping

To arrive at the stage of your cancer, your healthcare provider first assigns numbers for the T, N, and M groups. These numbers are then combined in a process called stage grouping to give the cancer an overall stage. The lower the number, the less the cancer has spread. The higher the number, the more the cancer has spread.

These are the stages of pancreatic cancer and their definitions. Ask your healthcare provider to help explain your cancer's stage to you:

Stage 0:

The tumor is only in the top layer of the pancreatic duct cells. It has not invaded deeper. This may be called pancreatic cancer in situ.

Stage IA:

Cancer is only found in your pancreas. It’s no larger than 2 centimeters across.

The cancer has not spread to your lymph nodes or to distant parts of your body.

Stage IB:

Cancer is only found in the pancreas. It’s larger than 2 centimeters across.

The cancer has not spread to your lymph nodes or to distant parts of your body.

Stage IIA:

The cancer hasgrown outside your pancreas but has not grown into nearby major blood vessels or nerves.

It has not spread to nearby lymph nodes or to distant sites.

Stage IIB:

The cancer may or may not have grown outside your pancreas, but it has not grown into nearby major blood vessels or nerves.

It has spread to nearby lymph nodes, but it has not spread to distant sites.

Stage III:

The cancer has spread to nearby major blood vessels or nerves.

It may have spread to nearby lymph nodes, but it has not spread to distant sites.

Stage IV:

The cancer has spread to organs further away from the pancreas. This might include the liver, lining of the abdomen (called the peritoneum), or the lungs.

Healthcare providers use the TNM system to formally stage pancreatic cancer. However, for practical reasons, they often use a simpler system when trying to decide the best treatment. They may divide cancer into three main groups.

Resectable cancer

These cancers can be surgically removed (resected). This includes many cancers that are still confined within the pancreas or have grown just outside of it.

Borderline resectable cancer

These cancers might be able to be surgically removed. But they are very close to major blood vessels. For these cancers, treatments other than surgery might be tried first to try to shrink the tumor and make it resectable.

Unresectable cancer

These cancers cannot fully be removed with surgery:

Locally advanced cancer. These cancers are still only in the area around the pancreas, but they cannot be fully removed with surgery. This is often because they’re growing into nearby blood vessels. This means that they’re unresectable.

Metastatic cancer. These cancers have spread to distant parts of your body, so they cannot be removed completely with surgery. Surgery may still be done, but it's used to relieve symptoms, not to try to cure the cancer.

Talking with your healthcare provider

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Make sure to ask any questions or talk about your concerns.